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<html>
    <head>
        <title></title>
        <meta http-equiv="Content-Type" content="text/html; charset=UTF-8">
        <script  type="text/javascript" src="js/script.js"></script>
        <link type="text/css" rel="stylesheet" href="css/style.css"/>
    </head>
    <body>        
        <div id="content">
            <h1>Cadastrar/Editar Paciente</h1>
            <div id="menu">
                <ul>
                    <li><a href="homeSecretary.html"> Página Inicial</a></li>
                </ul>
            </div>
            <form name="add-up-paciente" action="#" method="post">
		<div id="erro"></div>
                <fieldset>
                    <legend>Dados Pessoais</legend>
                    <table>
                        <tr>
                            <td colspan="3"><label for="nomePaciente">Nome: <input type="text" name="nomePaciente" id="nomePaciente" onblur="return validate(this,validStringAlpha,'paciente');"/> </label></td>                            
                        </tr>
                        <tr>
                            <td><label for="rgPaciente">RG: <input type="text" name="rgPaciente" id="rgPaciente" onblur="return validate(this,validRG,'RG');" > </label></td> 
                            <td><label for="cpfPaciente">CPF: <input type="text" name="cpfPaciente" id="cpfPaciente" onblur="return validate(this,validCPF,'CPF');"> </label></td>
                            <td><label for="dataNascPaciente">Data Nascimento: <input type="text" name="dataNascPaciente" id="dataNascPaciente" onblur="return validate(this,validData,'data de nascimento');"/> <span class="aux">00/00/0000</span> </label></td>
                        </tr>
                    </table>
                </fieldset>
                <fieldset>
                    <legend>Dados Contato</legend>
                    <table>
                        <tr>
                            <td colspan="2"><label for="emailPaciente">Email: <input type="text" name="emailPaciente" id="emailPaciente" onblur="return validate(this,validEmail,'email');"/> </label></td>
                        </tr>
                        <tr>
                            <td colspan="2"><label for="enderecoPaciente">Endereço: <input type="text" name="enderecoPaciente" id="enderecoPaciente" onblur="return validate(this,validNotNull,'endereço');"/></label></td>                            
                        </tr>
                        <tr>
                            <td colspan="2">
                                <label for="ufPaciente">Estado: 
									<select id="ufPaciente" name="ufPaciente">
										<option value="">SELECIONE</option>
										<option value="AC">ACRE</option>
										<option value="BA">BAHIA</option>
										<option value="DF">DISTRITO FEDERAL</option>
										<option value="ES">ESP&Iacute;RITO SANTO</option>
										<option value="GO">GOI&Aacute;S</option>
										<option value="MA">MARANH&Atilde;O</option>
										<option value="MG">MINAS GERAIS</option>
										<option value="MS">MATO GROSSO DO SUL</option>
										<option value="MT">MATO GROSSO</option>
										<option value="PA">PAR&Aacute;</option>
										<option value="PB">PARA&Iacute;BA</option>
										<option value="PI">PIAU&Iacute;</option>
										<option value="PR">PARAN&Aacute;</option>
										<option value="RJ">RIO DE JANEIRO</option>
										<option value="RN">RIO GRANDE DO NORTE</option>
										<option value="RO">ROND&Ocirc;NIA</option>
										<option value="RR">RORAIMA</option>
										<option value="RS">RIO GRANDE DO SUL</option>
										<option value="SC">SANTA CATARINA</option>
										<option value="SP">SÃO PAULO</option>
										<option value="TO">TOCANTINS</option>
									</select>
                                </label> 
                                <label for="cidPaciente">Cidade: <input type="text" name="cidPaciente" id="cidPaciente" onblur="return validate(this,validNotNull,'Cidade');"/></label>
                            </td>                            
                        </tr>
                        <tr>
                            <td><label for="telPaciente">Telefone: <input type="text" name="telPaciente" id="telPaciente" onblur="return validate(this,validFone,'telefone ');"/> <span class="aux">(00) 0000-0000</span>  </label></td>
                            <td><label for="celPaciente">Celular: <input type="text" name="celPaciente" id="celPaciente" onblur="return validate(this,validFone,'celular');"/> <span class="aux">(00) 0000-0000</span> </label> </td>
                        </tr>
                    </table>
                </fieldset>
                <fieldset>
                    <legend>Dados Saúde</legend>
                    <table>
                        <tr>
                            <td><label for="tpConvPaciente">Tipo Convênio: </label></td>
                            <td>
                                <select name="tpConvPaciente" id="tpConvPaciente">
                                        <option>Selecione seu convênio</option>
                                        <option>Particular</option>
                                        <option>Plano de Saúde</option>
                                </select>
                            </td>
                        </tr> 
                    </table>
                </fieldset>
                
                        <input type="reset" value="Cancelar"/>
                        <input type="submit" value="Salvar"/>
            </form>
        </div>
    </body>
</html>
